Heart involvement in metastatic carcinoid disease

Area of Science:

• Cardiology
• Oncology
• Gastroenterology

Background:

• Metastatic carcinoid tumors, particularly from ileal or cecal origins, can lead to carcinoid heart disease.
• Cardiac involvement in carcinoid syndrome is often assessed in patients with significant symptoms.

Purpose of the Study:

• To evaluate the frequency and degree of cardiac involvement in a non-selected group of patients with metastatic ileal or cecal carcinoid tumors.
• To investigate the correlation between plasma hormone levels (5-hydroxytryptamine and substance P) and cardiac involvement.

Main Methods:

• Physical examinations, electrocardiograms, chest x-rays, cardiac catheterization, and echocardiography were performed on 16 patients.
• Plasma levels of 5-hydroxytryptamine (5-HT) and substance P were analyzed.

Main Results:

• Carcinoid heart involvement was detected in 3 of 16 patients (19%), with no subjective cardiac symptoms.
• Four patients (25%) exhibited slight pulmonary hypertension; no left-sided heart lesions were observed.
• No correlation was found between plasma 5-HT or substance P levels and the presence or degree of heart involvement.

Conclusions:

• Carcinoid heart disease is less common in this non-selected patient group compared to previously studied cardiologically selected cohorts.
• Echocardiography is highly effective for detecting subclinical cardiac involvement and monitoring its progression.
• Cardiac failure was not the cause of death in any of the eight patients who died during follow-up.